Early and late results of contemporary management of 37 secondary aortoenteric fistulae

Eur J Vasc Endovasc Surg. 2011 Jun;41(6):748-57. doi: 10.1016/j.ejvs.2011.02.020. Epub 2011 Mar 16.

Abstract

Purpose: Evaluate the results of the two modalities used for the treatment of Secondary Aorto-Enteric Fistula (SAEF): In situ Reconstruction (ISR) and Extra-Anatomic Reconstruction (EAR). The primary endpoints of this study were early standard 30-day mortality and reinfection (RI). Secondary endpoints were perioperative morbidity, late mortality, primary graft patency, and major amputation rates.

Material & method: Diagnosis of SAEF was based on clinical examination and the results of pre-operative duplex or CT scans. Surgical management was performed according to local protocols at the participating institutions: - Elective surgery: ISR or staged EAR. - Emergency surgery: aortic clamping followed by ISR or EAR. - Selected high-risk patients: endovascular repair. Statistical analyses were performed using the actuarial method. Univariate analysis was used for analysis of categorical variables, and multivariate analysis was performed with a Cox proportional hazard regression.

Results: A total of 37 patients were included in this retrospective multicentre study. Mean follow-up was 41 months. The majority of the patients (20, 54%) presented acutely. EAR was performed in 9 patients (24%), ISR in 25 (68%), and 3 patients underwent endovascular repair. Bacteriological cultures were negative in 3 patients (9%). The most frequent organisms identified were Candida species and Escherichia coli. The 30-day mortality was 43% (16 patients). Patient age (>75 years) was the sole predictive factor associated with operative mortality (p = 0.02); pre-operative shock was not statistically significant (p = 0.08). There were 2 graft thromboses and 1 femoral amputation. Primary graft patency was respectively 89% at 1 year and 86% at 5 years; limb salvage rates were 100% at 1 and 5 years and 86% at 6 years, with no difference between ISR and EAR. RI occurred after 9.3 ± 13 months in 8 of 17 surviving patients and was fatal in all cases. For all surviving patients, the RI rate at 1 and 2 years was 24% and 41% respectively. There was no significant difference in the rate of RI after ISR or EAR.

Conclusion: EAR does not appear to be superior to ISR. The risk of RI increased with the length of follow-up, irrespective of the treatment modality. Life-long surveillance is mandatory. Our results with endovascular sealing of SAEF should be considered a bridge to open repair.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty*
  • Aortic Diseases / etiology
  • Aortic Diseases / mortality
  • Aortic Diseases / therapy*
  • Blood Vessel Prosthesis
  • Follow-Up Studies
  • Humans
  • Intestinal Fistula / etiology
  • Intestinal Fistula / mortality
  • Intestinal Fistula / therapy*
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / etiology
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / therapy
  • Reconstructive Surgical Procedures*
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Fistula / etiology
  • Vascular Fistula / mortality
  • Vascular Fistula / therapy*